Tamura Nobuko, Hasebe Takahiro, Okada Nao, Houjoh Takashi, Akashi-Tanaka Sadako, Shimizu Chikako, Shibata Tatsuhiro, Sasajima Yuko, Iwasaki Motoki, Kinoshita Takayuki
Department of Breast Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo.
Cancer Sci. 2009 Oct;100(10):1823-33. doi: 10.1111/j.1349-7006.2009.01264.x. Epub 2009 Jun 26.
The present study investigated fibrotic foci (FFs), the grading system for lymph vessel tumor emboli (LVTEs), and the histological characteristics of nodal metastatic tumors that were significantly associated with the outcomes of 115 patients with invasive ductal carcinoma (IDC) who had received neoadjuvant chemotherapy. We compared the outcome predictive power of FFs, the grading system for LVTEs, and the histological characteristics of metastatic tumors in lymph nodes with the well-known clinicopathological characteristics of tumor recurrence and tumor-related death in multivariate analyses. The presence of FFs, as assessed by a biopsy performed before neoadjuvant chemotherapy, significantly increased the hazard rates (HRs) for tumor-related death in all the cases and in cases with nodal metastasis. The grading system for LVTEs, which was assessed using surgical specimens obtained after neoadjuvant chemotherapy, was significantly associated with increasing hazard rates (HRs) for tumor recurrence and tumor-related death in all the cases and in cases with nodal metastasis. Moderate to severe stroma in nodal metastatic tumors and five or more mitotic figures in nodal metastatic tumors were significantly associated with elevated HRs for tumor recurrence and tumor-related death among all the cases. These results indicated that FFs, the grading system for LVTEs, and the histological characteristics of tumor cells in lymph nodes play important roles in predicting the tumor progression of IDCs of the breast in patients treated with neoadjuvant chemotherapy.
本研究调查了115例接受新辅助化疗的浸润性导管癌（IDC）患者的纤维化病灶（FFs）、淋巴管肿瘤栓子（LVTEs）分级系统以及淋巴结转移性肿瘤的组织学特征，这些因素与患者预后显著相关。在多因素分析中，我们将FFs、LVTEs分级系统以及淋巴结转移性肿瘤的组织学特征的预后预测能力与众所周知的肿瘤复发和肿瘤相关死亡的临床病理特征进行了比较。新辅助化疗前活检评估的FFs的存在显著增加了所有病例以及有淋巴结转移病例中肿瘤相关死亡的风险率（HRs）。使用新辅助化疗后获得的手术标本评估的LVTEs分级系统与所有病例以及有淋巴结转移病例中肿瘤复发和肿瘤相关死亡风险率（HRs）的增加显著相关。淋巴结转移性肿瘤中中度至重度间质以及淋巴结转移性肿瘤中五个或更多有丝分裂象与所有病例中肿瘤复发和肿瘤相关死亡的高风险率显著相关。这些结果表明，FFs、LVTEs分级系统以及淋巴结中肿瘤细胞的组织学特征在预测接受新辅助化疗的乳腺癌IDC患者的肿瘤进展中起着重要作用。
